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GPN'1' LIAME:_ F IND GRANT # AMOUNT OF GRANT: S 4 3.9 3 3.0 0 DEPARTMENT RECEIVING GRANT: Public Works Department CONTACT PERSON: James W. Davis, P.E. PHONE N[JMBER: (4 0 7) 567-8000 ext . 245 1. How long is thegrant for? 1 yr. from date of exe ution 2. Does the grant require you to fund this function after the grant is over? 3. Does the grant require a match? If yes, does the grant allow the match to be in In Kind Sevices? 4. Percentage of match to grant -n- 3. n -S. Grant match amount required 5 4 3.9 3 3.0 0 Starting Date: D a t e of Execution Yes X X No Yes -1,L—No Yes _ j _No 6. Where are the matching funds coming from (i.e In kind Services; Reserve for Contingency)? None Required 7. Does the grant cover capital costs or start-up costs? X X Yes No If no, how much do you think will be needed in capital costs or start up costs? (Attach a detail listing of costs) S -0- 8. 0- g. Are you adding any additional positions utilizing the grant funds? Yes _U_N0 No If yes, please list. (If additional space is needed, please attach a schedule.) Acct. Description Position Position Position Position Position 011.12 Re lar Salaries 0 s 011.13 Other Salaries & Wages PT 0 $ 0 12. 11 Social Security- 0 ar 012.12 Retirement -Contributions 0 $ 012.13 Insurance -Life & Health Worker's Compein ation 012.14 0 012.17 S/Sec. Medicare Matching 0 9. What is the total cost of each position including benefits, capital, start-up, auto expense, travel and operating? Salary and Benefits Operating Costs Capital Total Costs 0 10. What is the estimated cost of the grant to the county over five years? S -0- Grant n - 7FOurth Fant Amount S Other Match Costs Not Covered S Match S Total $ ar $ s S S r $ S $ $ ar S $ S $ Signature of Preparers W • Date: